Healthcare Provider Details

I. General information

NPI: 1477623320
Provider Name (Legal Business Name): MAMAKATING FIRST AID SQUAD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 SULLIVAN ST
WURTSBORO NY
12790
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 845-888-2544
  • Fax:
Mailing address:
  • Phone: 800-927-5845
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number5222
License Number StateNY

VIII. Authorized Official

Name: FRANK SISCO
Title or Position: PRESIDENT
Credential:
Phone: 845-866-4818